Deaths at home increase as hospital mortality rates drop

The proportion of people dying in hospitals in England has decreased over the past 10 years, while deaths at home or in care homes have increased, according to new analysis of official data.

Public Health England, which collated the data, claimed that the trend indicated that end of life care was improving because previous research has shown the vast majority of people would like to die out of hospital.

“We are now a step closer to balancing out the number of people using hospital and community care”

Julia Verne

Mortality data from 2013 shows 44% – 207,764 – of deaths were at home or in a care home, compared to 35% – 166,749 – in 2004.

In particular, deaths at home have increased from 18% in 2004, to 22% in 2013.

The proportion of people dying in hospitals has dropped, from 57% in 2004 to 48% in 2013, meaning a reduction of 50,000 deaths in this setting over nearly 10 years.

Previous surveys have found the preferred place for dying is at home, with the government’s 2013 National Survey of Bereaved People finding that 79% of wanted to die in this setting, 8% in a care home and 3% in hospital.

PHE’s National End of Life Care Intelligence Network – which led the data analysis that it collated along with recent research and evidence in its report What We Know Now 2014 – said the NHS was now “a step closer” to achieving a more even spread of people receiving end of life care in and out of hospital.

“Inclusion of death and dying in undergraduate training could help to change the current culture that considers death to be a medical failure”

PHE report

Professor Julia Verne, clinical lead at PHE’s National End of Life Care Intelligence Network, said: “It is of course appropriate for some patients to die in hospital but this year’s findings are encouraging as our understanding of what patients want continues to improve.

“There is still work to be done to ensure we keep focus, not just on the numbers but on people’s experience of dying,” she said. “However we are now a step closer to balancing out the number of people using hospital and community care.”

It found that while more than 80% of trusts had provided some form of training in this area in the previous year, it was only mandatory for nurses in 28% of trusts and in 19% for doctors.

“Inclusion of death and dying in undergraduate training could help to change the current culture that considers death to be a medical failure,” stated the PHE report.

It also highlighted research that found people’s top priority when dying was to be pain free, but that pain management was reported by bereaved relatives as being at a significantly lower level for patients at home compared to other settings.

Nurses and other clinicians must receive tailored training to address the lack of confidence and skills they have in raising end of life issues with patients, a report by the Commons’ health select committee has said.

Having too few trained nurses on hospital wards is linked with a daily 3% increase in the risk of patient death, which does not reduce when staffing gaps are plugged with nursing assistants, new UK research has found.

Sepsis-related deaths in the UK have fallen in the past three decades but continue to be above average for well-off countries, according to a new study.

Readers' comments (4)

Anonymous26 June, 2015 9:39 pm

It's good that people are able to die at home if they choose but the final paragraph highlights the need to provide better community palliative nursing care. I work in a team that provides 24/7 care and we often receive calls regarding palliative patients at night. We are not a specialist palliative team but we do our best. That's not good enough for patients who should receive round the clock specialist palliative care in their own homes.

The word 'mortality' bothers me in connection with this - usually mortality 'is a bad thing' and it tends to bring to mind 'people dying unnecessarily'.

This is not about 'whether people would die', it is about where people who are dying, do die - I think a better 'banner' would be 'More people achieving their wish to die at home'.

Anonymous | 26-Jun-2015 9:39 pm

There is an awful lot which needs to be improved for 'death at home' - notably post-mortem behaviour, which unlike increased resources (and I'm sure you are right - I feel sure that community nursing is struggling to meet the '24/7' care that bodies like Marie Curie and many others, are calling for) simply requires a different [and more perspective balanced] 'attitude':

I've now read this report. It is a collection of recent research/guidance related to end-of-life and dying, with links to the references [which could be useful to people].

It is also unusual, in that I cannot actually find anything in it to object to: but that is only because it doesn't look into my concerns about EoL at home, at all (so I'll be sending comments about that to the NEOLCIN).

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